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Contact Information

COMMONWEALTH OF MASSACHUSETTS
60 MAIN STREET
3RD FLOOR
BROCKTON, MA02301
 Phone: 508-427-5731
 Fax: 508-586-9316
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Case Management

251B00000X
Indicates primary specialty

NPI Profile & details for COMMONWEALTH OF MASSACHUSETTS

NPI # 1245364595
LBN Legal business name COMMONWEALTH OF MASSACHUSETTS
Authorized official DYLAN LATTIMORE - (DEPUTY COMMISSIONER OF ADMINISTRAT)
Entity Organization
Organization subpart 1 Yes
Enumeration date 03/16/2007
Last updated 03/19/2026 - About 3 months ago
Identifiers
License # EXAMPT
MA Medicaid 110000085O
MA Medicaid 1813471
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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